Adopting and sustaining a Virtual Fracture Clinic model in the District Hospital setting - a quality improvement approach

Abstract

Virtual Fracture Clinics (VFCs) are an alternative to the conventional fracture clinics, to manage certain musculoskeletal injuries. This has recently been reported as a safe, cost-effective and efficient care model. As demonstrated at vanguard sites in the United Kingdom, VFCs can enhance patient care by standardising treatment and reducing outpatient appointments. This project demonstrates how a Quality Improvement approach was applied to introduce VFCs in the District General Hospital setting. We demonstrate how undertaking Process Mapping, Driver Diagrams, and Stakeholder Analysis can assist implementation. We discuss Whole Systems Measures applicable to VFCs, to consider how robust and specific data collection can progress this care model. Three Plan-Do-Study-Act cycles led to a change in practice over a 21-month period. Our target for uptake of new patients seen in VFCs within 6 months of starting was set at 50%. It increased from 0% to 56.1% soon after introduction, and plateaued at an average of 56.4% in the six-months before the end of the study period. Careful planning, frequent monitoring, and gathering feedback from a multidisciplinary team of varying seniority, were the important factors in transitioning to, and sustaining, a successful VFC model.

Figure 1

A driver diagram for achieving a safe, patient centred virtual clinic model for orthopaedic injuries

Figure 2

A patient flow-diagram in the traditional fracture clinic model

Figure 3

A patient flow-diagram in the virtual fracture clinic model Reference: adapted from Glasgow Royal Infirmary Orthopaedic Department (2015). “Fracture Clinic Redesign.” Retrieved 23rd March, 2016, from http://www.fractureclinicredesign.org/.

Figure 4

The change package, segmenting the plan for implementation of a novel virtual fracture clinic model